Testing advice for Lucy

[jabojenny]

I am fostering an eight year old Havanese, Lucy, with possible Cushings. Her results from a low dex suppression test came back inconclusive. My vet suggested waiting a month and retesting. My vet said this test was only 80% accurate. Any opinions on that? She suggested running the low dex test again but I was wondering if we should go with the ACTH stim test instead. Has anyone tried a urine cortcoid: creatinine ratio test to help with diagnosis? Her only symptoms are hair loss and thick skin issues, no excessive drinking, panting etc... I will attach a picture showing her hair loss. She already had a thyroid panel that came back fine. Someone suggested getting a skin biopsy. Sebaceous Adenitis?

I also had a couple questions regarding what products to use when I give her a bath. I have only had her a short time and she just got a dental and shave down so now I'd like to tackle getting her clean. Do any of you have issues using topical flea/tick preventatives like K9 Advantix? We have loads of ticks here and one of my pups has already had Lyme so I need to use something.

Thanks,
Jen

http://www.k9cushings.com/forum/picture.php?albumid=1157&pictureid=8721

[labblab]

Hello and welcome to you and little Lucy! It will help us a great deal if you can provide the actual numbers for Lucy's LDDS test. I'm assuming "inconclusive" means "negative," but it will help us to see the numbers for ourselves. We have had a few dogs here who have tested negative on the LDDS and positive on the ACTH. So it can happen, but it's not common. This is because the LDDS typically does a good job of returning a positive result in a dog who truly does have Cushing's. It is not so good the other way around -- it is more likely to return a false positive in a dog who suffers from some disease or illness other than Cushing's. But in terms of trustworthiness of negative results, we've been told it's more within the 90-95% range.


If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

So you're right: for a dog with strong Cushing's symptoms, the next step would be an ACTH. However, that's the catch for Lucy, because other than the skin and coat, Lucy doesn't exhibit other Cushing's symptoms. So in honesty, if it was me, I would likely put the money towards a consultation with a veterinary dermatologist if there is one available to you. For instance, in addition to the possibility of Sebaceous Adenitis, there is a condition called "Alopecia X" that might be responsible for the symptoms you are seeing.

http://www.petwave.com/Dogs/Health/Black-Skin-Disease/Symptoms.aspx

I will add that you could indeed opt for a urinary UC:CR test, but bear in mind that an elevated result on that test does not confirm Cushing's. You'd still have to move forward with an ACTH if the result was abnormal. If the result was within normal range, however, you'd have even more reason to dismiss Cushing's as a possibility. So that might be an option. If you do pursue a UC:CR, the urine should be collected at home, first catch of the day. We've been told that pooling three days worth of morning samples is optimal. Do not have the vet collect the sample in the office, because the test is highly sensitive to stress. A stressed but healthy dog can have an elevated result simply due to the stress alone.

So going back full circle, if you can give us the results for the LDDS, that would be great. Also, has she had abnormal results on any other general blood or urinalysis panels? A dog who truly has Cushing's typically exhibits certain other abnormalities in addition to "positives" on the diagnostic blood tests.

Marianne

[DoxieMama]

Hi Jen,

Welcome to you and Lucy! Marianne has covered the questions and ideas I had, so just wanted to pop in and say a great big THANK YOU for fostering!

I look forward to learning more about this sweet little one.

[jabojenny]

Thanks ladies, great advice and so appreciated. I will get in touch with my vet and get her numbers to you. She's had a CBC, thyroid panel along with the low dex test.

Lucy is a very sweet girl but was not taken care of too well. She came to me with ear mites, round worm and terrible teeth along with this hair loss. We're working hard to get her happy and healthy. Has anyone used this shampoo and rinse? I need to get her bathed and her skin is so intimidating. My vet sent me home with these.

http://www.k9cushings.com/forum/picture.php?albumid=1157&pictureid=8722

[molly muffin]

Aww, poor little Lucky. Good for you to take her in and foster her. I'm thinking a dermatologist would be a good bet. I've seen dogs tests do well after a good dental when their teeth are bad. All sorts of things can improve after their teeth are doing better.
I'd definitely ask about a skin scrapping and even a biopsy if that was inconclusive or nothing found.
Did they check for mites on the body also? that can cause hair loss.

I always used revolution on my dog for heart worm and flea prevention. She never had a flea or tick so think it worked pretty good.

Lucy is adorable. That face is just so precious. I'd try the shampoo and cleaner that the vet gave you and see how she does. I haven't used them myself.

A decent antibiotic spray for dogs, trichlor spray (can find it on amazon) might work and I know they have shampoos' too.

[jabojenny]

Hi Everyone,
Sorry for the delay. I took Lucy to a dermatologist yesterday. Her only symptom for Cushings was hair loss so I had my doubts that was what is was. Derm doc doesn't think it looks like Cushings but perhaps sebaceous adenitis which was my first thought. She got some skin scapings and two skin biopsies to confirm SA and we'll know in a couple weeks. I am attaching her report from yesterday, which also includes all her previous test results. If anyone wants to share their thoughts as to if this could be Cushings based on her numbers they would be most welcomed. My original vet wanted to retest for Cushings again in a month but that might not be necessary if SA is confirmed.

Thanks,
Jen


http://www.k9cushings.com/forum/picture.php?albumid=1157&pictureid=8730

[DoxieMama]

Here are the test results from the picture:


On 1/24:
CBC/Chem -LYM 0.7L
MON 0.19L
MCH 25.9H
MCHC 39.4H
MPV 11.4H
GLU 114H
T4 3.6

UA on 2/1 1.030, trace PRO

LDDS test 2/2:
Pre: 6.5
4hr: 0.3
8hr: <0.2

[Harley PoMMom]

The good majority of dogs, 80-90%, with Cushing's have a very elevated ALP. Other lab anomalies generally found in cushdogs are high cholesterol and triglyceride levels. They also have what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS). Also, dog's with Cushing's have diluted urine with a low specific gravity. From your post it seems that Lucy's blood work and urinalysis does not show any of these abnormalities.

So, adding the negative result from Lucy's LDDS test along with her blood work I believe the chances of Lucy having Cushing's disease is very unlikely.

I hope the dermatologist vet will be able to help Lucy with her skin and hair issues. Please do keep us updated.;)

Hugs, Lori

[jabojenny]

Just wanted to thank everyone for their generous advice while we were trying to diagnose Lucy. We did get skin biopsy results back and confirmed Sebaceous Adenitis. This is not such a great diagnosis but I so consider it better then an Cushing's diagnosis since it's not life threatening but also not curable. We're starting on baths with special shampoos, oil soaks and taking Accutane. I'm hoping we can get her skin back in shape although the vet doubts there will be any hair regrowth. I'll be fostering her through this process and am hopeful we can work up a manageable regimen for a future adopter. Thanks again everyone and best of luck with your sweet pups!

[Squirt's Mom]

Well, I'm glad you have a confirmed diagnosis but just because it's not Cushing's doesn't mean you have to leave us. ;) You and Lucy are family so please come back from time to time and let us know how things are going. You are an angel for fostering her and giving her a chance at a normal life. It isn't easy, I know - I worked with special needs and hospice babies in rescue and each one takes a piece of your heart when they have to leave but it is truly rewarding work. They each one brings a lesson only they can teach. She is blessed to have you!

Hugs,
Leslie and the gang

[molly muffin]

I second what Leslie said. I'm glad it's not cushings and that you at least know what it is. I'm sure there is a home out there for Lucy with someone who can give her great care and a wonderful life thanks to you and all that you are doing for her now. Awesome job!